Understanding GHI Insurance Coverage for Rehab and Detox
If you’re inquiring about insurance coverage for mental health services or addiction treatment, the chances are high you’ve decided to take the brave step toward recovery. Seeking substance abuse treatment services is a stressful endeavor, especially when it comes to the financial aspect of the process.
At South Shores Detox, we partner with most major insurance agencies to help you secure the funding you need to receive the addiction treatment services you need.
If you’re a recipient of GHI or curious about rehab that accepts GHI insurance for adequate recovery support, the following guide breaks down everything you need to know about our addiction treatment program and this specific provider.
Coverage for Addiction Treatment and Mental Health Services
Unfortunately, many would-be clients of South Shores Detox allow a lack of information regarding services covered by EmblemHealth—or insurance coverage in general—to stop them from receiving proper addiction treatment services. However, this roadblock ceased in 2010 after the Affordable Care Act.
This legislation made it mandatory for insurance agencies to offer mental health treatment services, inpatient rehab programs, and other care levels. The Affordable Cares Act Marketplace was created as a source for every American to purchase affordable insurance, including the services mentioned above.
Failure to provide funding for addiction treatment or mental health disorders as an essential health benefit can potentially lead to an insurance agency losing its privileges to sell its services on the ACA Marketplace. In this way, behavioral health services are required to be covered by EmblemHealth insurance.
Who Is GHI Insurance?
GHI, otherwise known as Group Health Incorporate, provides insurance for those seeking addiction treatment or mental health disorders. Group Health Incorporated is a subsidiary for clients covered by EmblemHealth—a more extensive insurance provider based out of New York.
One of the most frequently asked questions we receive regarding GHI is: what substance abuse and mental health treatment programs are covered by my policy? First, it’s essential to know that if EmblemHealth Insurance covers you, you likely receive the same benefits as GHI, considering the latter is a subsidiary.
The amount of coverage you receive depends on your specific policy. However, regardless of your plan, you receive at least partial payment for the services listed below.
What Mental Health Disorders and Substance Abuse Services are Covered by GHI?
EmblemHealth Insurance and the GHI Insurance companies cover the following services:
- Inpatient rehab programs
- Intensive outpatient programs
- Alcohol addiction treatment
- Standard outpatient treatment
- Partial hospitalization programs
- Mental health treatment
Some plans even offer coverage for residential arrangements. However, it’s essential to distinguish between inpatient and residential programs. The latter typically refers to a halfway house client’s transition after inpatient treatment.
In addition to intensive outpatient programs and other care levels covered by EmblemHealth and GHI, many specific therapeutic plans are covered during drug and alcohol addiction treatment.
Individual and Group Therapy Sessions
Individual and group therapy sessions during drug and alcohol addiction treatment at South Shores Detox include several potential program options. Individual therapy sessions during mental health or drug and alcohol rehab include, but aren’t limited to:
- Cognitive behavioral therapy
- Dialectic behavior therapy
- Exposure therapy
- Trauma-informed therapy
Group therapy sessions also cover several different settings. Clients can participate in peer group therapy sessions during inpatient treatment, and family members may be invited to join in group family therapy during all substance abuse care levels.
Medication-Assisted Treatment Programs
During partial hospitalization programs, inpatient and residential programs, and outpatient treatment at rehab centers, clients may opt to participate in a medication-assisted treatment program for substance abuse.
These programs are typically reserved for clients who are receiving substance abuse treatment for some form of opioid, such as heroin, fentanyl, oxycodone, or other substances. MAT consists of methadone or suboxone maintenance programs. If you’re prescribed MAT for substance abuse, your insurance plan likely covers a portion of the cost of your medication.
If you’re interested in MAT and would like to know more about your specific coverage provided by GHI Insurance, please contact a member of our team today.
Medication Plans
During addiction treatment, many clients require medication plans or medication management. Many times, clients come to us with substance use disorders; we also find that they suffer from a mental health disorder at the core of their addiction.
These instances can require medication management to keep the side effects of the mental health disorder at bay until recovery begins through counseling and other forms of therapy. The primary goal is for medication plans to be a temporary portion of a larger personalized treatment plan.
The amount of coverage provided for your medication depends on your specific GHI plan. These medication plans are typically part of a treatment known as dual-diagnosis therapy, another program covered by GHI.
Dual Diagnosis/Co-Occurring Disorders
In the past, many substance abuse and mental health experts considered and treated both conditions separately. Unfortunately, this led to higher cases of relapse. As time moved forward, research has demonstrated that most substance use disorders have a mental health disorder at the root of the addiction.
There’s no limit to the type of mental health disorder that may be connected to your addiction during a co-occurring disorder. GHI covers treatment for the following mental health disorders and more:
- Anxiety
- Depression
- PTSD
- OCD
- Schizophrenia
- Bipolar disorder
- Dissociative identity disorder
- Social anxiety
- Anorexia/eating disorders
Medically-Assisted Detox
Your GHI plan covers medically assisted detox, a process that typically takes place before inpatient or outpatient programs. Certain drugs, like opioids, benzodiazepines, and alcohol, cause severe physical dependence.
Moving forward, even with the most effective substance abuse treatment programs, is difficult without first going through the withdrawal process. For many, this is next to impossible because of the pain and discomfort associated with the body’s detoxification of your substance of choice.
Clients have a substantial need for several medical and addiction treatment resources during medically assisted detox. This includes medication to help relieve the pain and discomfort of withdrawal, 24-hour medical supervision, mental health support when needed, and other medical assistance as is necessary to help keep clients stable.
Now that you’re aware of several of the services covered by GHI insurance, you might still have questions about how your level of coverage is determined. In many cases, the information relayed to your insurance provider by South Shores Detox and other rehab centers regarding the severity of your addiction plays a substantial role in the level of coverage or specialized programs they’re willing to cover.
Sometimes, this requires a prior authorization form—essentially, a detailed report of the treatment recommended by our specialists at South Shores Detox. The following section details how we ensure you get the care you need.
How Is Your Level of Coverage Determined?
Many insurance providers rely on information relayed from the rehab facility to decide which services are covered or exactly how much is offered. In some cases, specialized programs, such as holistic therapy, medically assisted detox, and others, require this information.
How to Help South Shores Detox Create the Best Scenario for Your Treatment Plan
The first step in ensuring you receive the proper coverage is to reach out and make contact with our admissions department. Several essential items are critical and require 100% transparency from you as a new client. Areas of importance include:
Your Past with Substance Abuse
We must have a clear picture of your history of substance abuse. How long have you been using your drug of choice? Do you use more than one drug regularly? Questions like these are vital when determining your personalized treatment plan and dealing with your GHI insurance options and understanding the treatment services covered.
For example, if your drug of choice leads to physical side effects during the withdrawal/detox period, we must get you approved for medically-assisted detox.
Your Mental Health Status
Your current state of mental health is one of the most important dynamics, especially when it comes to dealing with your insurance provider. Clients who have a history of depression, anxiety, or other mental health disorders will likely require dual-diagnosis treatment.
Some clients are a good fit for our holistic treatment program. However, this all falls under the category of mental health and the intensity of therapy needed to get you on the road to recovery.
Your Support System
Your current support system and living situation are also important in determining the recommended level of care we present to your insurance provider. If you have a strong support system, hold down a regular job, and find it impossible to step away from your home life for an extended period, outpatient or intensive outpatient care might be the ideal choice.
However, if you lack a strong support system at home, have had difficulties maintaining housing, or have a particularly severe substance use disorder that’s heavily impacted your occupational and living situation, inpatient rehab with a transition to a residential program might be your best course of action.
Contact South Shores Detox to Find Options With GHI Today
Do you have a GHI policy? If you want to take the first steps toward recovery, we’d love to make you our next success story. We’ll handle all the legwork and deal with your agent, taking away the stress of calculating the specifics of your coverage.
Together, we’ll fight to get you the best coverage available, helping you reclaim your independence and enjoy long-term sobriety. Please make the confidential call for help now!